Sexual History Questionnaire Sexual History Step 1 of 7 14% Your Name DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your Life and Sexual History Questionnaire This questionnaire will ask you quite a few questions. Some will be general, about your life and you as a person. Others will be directly related to the accusations against you. I’d like you to be as honest as possible in answering these questions. It allows me to complete the most accurate and most helpful assessment. Please don’t be embarrassed. After 30 years of sexual evaluations, I’ve heard anything you might have to share. Let’s start with some background information. Who are the important people in your life?How long have you known each of them?How often do you speak to them?When was the last time you spoke to them?What kind of support are they offering you now?In what ways do you think they will be able to offer you support in the future?What sorts of problems have they helped you with in the past?What sorts of problems have you helped them with?Have they ever been in trouble with the law?Do they use/abuse alcohol or drugs?Have they ever been accused of committing a sexual offence?Do they know about your charges/offences?How do they feel about the way you have been treated by the criminal justice system?How do they feel about sex offender treatment (if this applies)?How do they feel about conditions or restrictions associated with your arrest or sentence?Intimate Relationships:Have you ever been in a long-term intimate relationship? Yes No If “yes”, describe your first long-term intimate relationship. At the end this section you can describe any current intimate relationship you are in. Their first name DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Did you live together? Yes No Were you married? Yes No When did this relationship end:Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920How did you feel emotionally with this partner?What did you have in common?What were some of the problems in the relationship?Was there any emotional, physical, or sexual abuse?Who ended the relationship? Why? (If they ended it, did you agree/understand their reasons?)Has family or friends ever intervened/interfered with this relationship?Have the police ever been called to the home?If you have been in additional long-term intimate relationships, please describe these here Your Current Relationship:Are you currently involved in a relationship? Yes No If you have not been in an intimate relationship for a long time, why?In general, what qualities are you looking for in a partner? Are these qualities hard to find?If you are currently in an intimate relationship: Their first name DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Did you live together? Yes No Are you married? Yes No Have you ever broken up or been separated in the past?How do you feel emotionally with this partner?What do you have in common?What are some of the problems in the relationship?Has there been any emotional, physical, or sexual abuse?Has family or friends ever intervened/interfered with this relationship?Have the police ever been called to the home?How does s/he feel about your current legal situation?Do you think that the relationship will survive your legal difficulties?FriendshipsHow easy is it for you to make new friends?What common interests/hobbies do you have with others?What do you talk about when you are together?Do you ever feel lonely? What makes you feel that way? How do you cope?Have you ever felt rejected by your community? What happened? How did you cope?Have you ever felt rejected by your family? What happened? How did you cope?Do you feel that other people care about you? Who?Overall, do you feel as well liked or “popular” as most other people?What would your friends say about you if I asked them?Who is your closest friend?How long have you known him/her?Please describe this person.Who is another close friend?How long have you known him/her?Please describe this person.Who is another close friend?How long have you known him/her?Please describe this person.Are there any children or teens in your life that you consider your friends?What types of activities do you do together?How do their parents/guardians feel about your friendship with them?Sometimes people feel more comfortable around younger people than they do around adults because they feel that children are more understanding or accepting of them. Have you ever felt that way? Tell me more about that.In your experiences, have you found it easier to start a conversation with someone who is around your own age or with someone younger?If you had a choice between spending time with someone younger doing something they enjoyed (such as playing video games or going to the playground) or spending time with an adult, which would you decide to do?If you had a choice between spending time with someone younger doing something they enjoyed (such as playing video games or going to the playground) or spending time with an adult, which would you decide to do?What do you perceive the role of a parent to be in their child’s activities? Relationships with WomenAre there any other women in your life that you feel close to?How does your partner feel about these friendships?Have you ever been sexually involved with any of these women?Do you think that it is difficult for men and women to be friends without it becoming sexual or there being sexual tension between them? Why or why not?Has anyone ever complained about your behavior towards women? What were the circumstances?Do you have any convictions for offences that involved women?What are your experiences working with women?Have you ever had a female supervisor? How did you feel about that? What was your experience like?Do you find that you need to change the way you speak or act when around women? Can you provide some examples?Have you ever had a woman make trouble for you? (i.e., Telling lies about you, making false accusations, interfering in relationships, having you fired from a job, etc.)Do you think that some women will say or do anything just to get a man into trouble? How often do you think this happens?Do you think that it is a good idea to have women involved in the criminal justice system? Why or why not? Were any involved in your case? Did they treat you fairly?Would things have been different if there had been men in these positions?WorkWhat do you do for employment?What do you like about your job?How well did you know your coworkers? Do you socialize with them outside of the workplace?GeneralHow do you relax when you are not working?What are your hobbies?What movies do you enjoy?What are your favorite TV programs?Are you involved in any community groups, sports teams or clubs?Do you attend Church or other religious services?Others in your life:How do you think your decisions and behaviors affect other people?How important is it for you personally to consider the feelings of others? What gets in the way of this?Do you feel that others are concerned with your feelings? How do you feel about that? What do you do about that?How would other people describe you?Do you think that their opinions of you are accurate? Are their opinions important?How do you think your accusations/offending has affected your accuser(s)?Their family and friends?Your family and friends? Impulsive TendenciesDo you consider yourself to be impulsive?If “yes”, what types of things do you do impulsively or on the spur of the moment?Do you ever do things on the spur of the moment and then wonder why you did them?How often does this happen?Do you ever buy things that you really cannot afford or really do not need?Have you ever got really mad if someone cut you off in traffic? What did you do?Have you ever taken something without permission or paying for it because you just wanted it? How often does this happen?Have you ever had difficulty managing your money? Do you live paycheck to paycheck? Do you having any savings? Any debt?Have you ever gotten into a bar-fight? What happened? How often does this happen?Have you ever quit a job without having another one to go to? How often do you change jobs?What are usually the reasons for this?Have you ever been fired for breaking the rules at work or for engaging in unsafe practices?Have you ever hurt yourself or someone else at work?Do you like exciting pastimes such as street racing, skydiving, or “extreme sports”? Have these activities ever led to a trip to the emergency department or admission to hospital?How many different residences have you lived in over the years? What were the reasons for moving?Have you ever moved without giving notice or providing family or friends with a forwarding address?Do you like taking risks? Could you give me examples of risks you have taken?Are you the type of person who likes to drive fast, or take chances when driving? Have you been arrested for speeding or dangerous driving?Have you ever bought things and then wondered why you bought them?Have you ever stolen anything that you didn’t really need?How often do you gamble? Has your gambling ever caused you problems?Have you ever had a disagreement with an unreasonable colleague/co-worker that led to a shoving match at work?How often do you drink alcohol or use drugs?Have you ever had a problem with drugs or alcohol? Has anyone ever complained about your use of alcohol or drugs?Do you ever find yourself making plans with others and then not showing up? What were the reasons for not showing up? Did something better come up at the last minute?Problem SolvingWhat sorts of things cause you problems in your life?What do you do about them?What do you think of the person who caused the problem? Do you meet people like that a lot?What do you do or say to deal with conflicts in your relationships? Who usually apologizes first?What do you do if you cannot resolve a conflict? Who is usually wrong?How do you deal with conflicts at work?With friends?Neighbors?What do you do if a plan you’ve made doesn't work?What about yourself would you like to work on or change?What would others say you should work on or change about yourself? Do they have valid concerns?Where do you see yourself in (five) years?How are you going to get yourself there? What obstacles might you encounter and how will you deal with them? EmotionsDo you ever feel like people are “just out to get you” or looking to harm you? How do you deal with people like that?How do you feel about your arrest and involvement in the criminal justice system? Do you feel you were dealt with fairly?Are there times when you feel that you cannot take it anymore or you just can’t cope? What has caused these situations?When was the last time that you felt like that? What did you do about it?When things go wrong, do you generally try to forget about it or do you find yourself focusing on it over and over in your mind?How does it make you feel when things go wrong or when you feel that things are out of your control? What do you do in those situations?How fair do you think your life has been generally?What kind of support have you received from family?Friends?Professionals?What happens when you ask others for help? What things could you do to improve your situation?Sexual HistoryChildhood and Adolescence As a child, how did you learn about human sexuality?As a child, did you engage in sexual exploration with same-aged peers?As a child, did you engage in sexual exploration with siblings?As a child, did an adult ever hurt you sexually?How old were you when you transitioned into puberty? What was this experience like for you?How old were you when you the first time you masturbated? How did you learn to masturbate?Did you ever masturbate with friends?How old were you when you engaged in your first sexual experience with another person (masturbation, oral sex, and/or coitus)?What was your relationship to the other person? (Stranger, girlfriend/boyfriend, peer, childhood sexual abuse)When was your first sexual intercourse with a woman? (if any)When was your first sexual experience with a man (if any)?Adult SexualityHow do you think your sex drive compares to other men your age? In your opinion is it higher than the norm, lower, or about average?Has anyone ever told you that you seem preoccupied with sex?Over your entire lifetime, how many long-term sexual relationships have you had with women?How many brief encounters have you had with women?How many long-term sexual relationships have you had with men?How many brief encounters have you had with men?Have you ever had sex with a prostitute?How often have you hired prostitutes? How much would you spend?If you’ve ever been married, did you ever have a sexual affair? MasturbationHow often do you masturbate?What do you usually fantasize about while masturbating?Was there ever a time you thought your masturbation was excessive? Has it ever gotten you into trouble or caused you pain?Have you fantasized about your alleged victim(s) while masturbating?Have you had sexual fantasies that would be illegal if they actually happened in the real world?PornographyHow old were you when you first saw pornography (magazines, videos, Internet)?How often do you view erotic material, such as magazines, videos, internet?Do you have a collection? Describe your collection?Does your partner know about your collection? How do they feel about it?How often do you search the internet for erotic material (images, videos, narratives)?How much time each week do you spend on the computer viewing porn?How often do you visit chat rooms? Which chat rooms do you visit?Was there ever a time you were watching too much pornography?VariousHow often do you attend strip clubs?How often have you gone to massage parlors for sex?Have you ever had sexual contact with someone in an adult bookstore?Has anyone ever said you are obsessed with pornography?Has anyone ever said you are obsessed with prostitutes?Has anyone ever told you that you have a “dirty mouth” because of the things that you say? Has this caused you problems with others?Have you ever engaged in a threesome or group sex activity? Couple swapping? How often? How did you initiate this with others?Do you have any special sexual interests that you think others generally do not or might not enjoy? What are they?Have they ever caused problems for you in your relationships?How often do you think about sex during the course of the day? What usually prompts a sexual thought? What do you think about?Sex as Coping:Are there times when you think about sex more than other times? What are these times?Do you ever engage in sexual behavior to feel better about yourself or your situation?When you feel lonely? Bored? Sad? Stressed? Angry? Frustrated? Down on yourself? After a fight with your partner or someone you care about?When are you most likely to feel sexual?What do you do when faced with a problem or difficult times? Is this how you usually respond?Do you ever drink or use drugs when faced with problems? How often do you use substances to deal with stress?What are you like when you are drunk/high?Do drugs or alcohol increase or decrease your interest in sex? In what ways?What was going on in your life in the period leading up to your alleged offence(s)?What kind of problems were you faced with? How did you deal with them?Did committing the offence(s) relieve some of your stress? Did it make you feel better, even temporarily?What happened to your sexual arousal when the victim resisted/was distressed? Was it more or less arousing?How were you able to maintain your arousal? Sexual InterestsHave you ever had a sexual thought that disturbed you or that you would be too embarrassed to tell someone about? What about the thought concerned you?How often do you think about children in a sexual way?What makes them sexually attractive?Are you interested in any unusual sexual things or activities?Have you ever exposed yourself in public? How often? Where?Have you ever looked in windows or washrooms to view people undressing or using the facilities? How often? Where? What type of person would you be most interested in looking at?Have you ever rubbed up against someone for a sexual purpose without their knowledge or consent? How often? Where? How would you choose the person?Have you ever had sex in a public place? How often? Where? With whom?Have you ever engaged in Sadomasochistic sexual activities? (Dominating/hurting someone or being dominated/hurt?)Do you have any special sexual interests? (Some people are sexually aroused by items, such as high-heels, stockings or rubber and some are aroused by engaging in certain activities such as urinating on another person or wearing clothes of the opposite sex.)Have they ever caused problems for you in your relationships?Do you collect any things related to your sexual interest?Have you ever engaged in sexual activity with an animal? How old were you? What were the circumstances? How often?Have you ever engaged in sexual activity with a family member? What were the circumstances?Have you ever engaged in a threesome or group sex activity? Couple swapping? How often? How was it initiated?Have you ever been sexually aroused or masturbated while watching something burn?What do you consider to be an unnatural or unusual sex act?Have you ever committed a sexual act while on the job?Have you ever lied to anyone about your sexual behavior?Regarding your current chargesWhat are the police alleging you did that led to your arrest? Please describe in detail what they say occurred to your alleged victim(s), type of sexual contact, frequency and duration (i.e. performed oral sex on victim 3 times over a 2 year period).How did these charges come about (who contacted the police, etc.).What do you say actually happened?This section is only for someone who is presently incarcerated.Did you plead guilty to your charges? Are you appealing your conviction or sentence? How fair do you think your sentence is?Have you experienced any trouble while in custody? Any institutional charges/misconducts?Have you previously been on parole or probation or some other form of supervised release? Any problems? Revocations? Additional charges?How do you feel about being on parole/probation?On the Sexual Offender Information Registry?Do you think it will be difficult for you to comply with the restrictions or conditions that may be placed on you?To date, what have you done to address your sexual offending/behavior?Who has tried to help you with your sexual behavior problems in the past? How did they assist you? Did you tell them everything they needed to know? What changes did you make to reduce your risk?What are your chances of getting into trouble for another sexual offence?What do you plan to do to make a re-offence less likely? What will you need to be careful of in the future?Have you ever stopped doing something you like to do because you were worried it might lead you into committing a sexual offence?Have you ever put yourself into a risky situation just to see if you could handle it? What was the situation? How did you know that you could handle it?How do you feel about being recommended for a sexual offender treatment program? Any concerns?What are the sexual crimes you are accused of?What did you enjoy about spending time with the victim(s)? What did you do together? Who suggested the activities that you engaged in with the victim(s)? What was your role in those activities?Have you ever done/been accused of something like this before?Why do you think you did it? Why do you think you were accused?